Checkers Checkers Checkers Checkers

LOW FOOD PRICES

Employment Appllcatlon
Contact Information
Name ___________________________________________________________________________________________________________
(last) (first) (middle) (maiden)

Present Address _____________________________________________ City ______________________ State ___________ Zip _______

Telephone (_______)_______-_______________ Cell Phone (_______)_______-_______________
ScheduIe AvaiIabiIity
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Hillcrest Foods, nc. dba Checkers is an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis
including race, color, age, sex, sexual orientation, religion, disability, or national origin/ancestry. All qualified applicants are encouraged to
apply. Consistent with the Americans with Disabilities Act, applicants may request accommodations needed to participate in this application.
PhysicaI Requirements
Due to local, state and federal legal restrictions we do not hire minors under the age of 16. Also, this store requires you to be of age to per-
form certain tasks such as (but not limited to) alcohol sales, use of a box knife, and use of heavy machinery.

Are you: Between the age of 16 and 18? Over the age of 18?

Are you physically capable of standing on your feet and/or walking for an extended period of time? Yes No

Are you physically capable of lifting 30 or more pounds on a regular basis? Yes No
Our store is open 24 hours a day, 7 days a week, and is only closed on December 25th in observance of Christmas Day. Every possible ac-
commodation will be made to provide days off as requested. However, all employees will be expected to be available to work holidays as
required by management unless arranged prior to the release of that week's schedule. Please note if you are willing to work overnights.
Position Desired
Please select any positions of interest (you may check as many as you want):

Carts Cashier Bakery Meat Deli Produce Grocery/GMD Dairy/Frozen Video Other

Have you ever applied to this company before? Yes No When? ________________________________________________

Have you ever worked for this company before? Yes No What position? _______________________ When? ____________

Were you referred to this position by a current employee? f so, who? ________________________________________________________

f you were offered a position, when would be the first day you could start? ____________________________________________________
EmpIoyment History
Please list your last four employers. nclude all temporary, seasonal, full time and part time employment. List in date starting with the MOST
RECENT first. Please include any military service if applicable.
From - To Name & Address of EmpIoyer Position Rate of Pay Supervisor Name Reason for Leaving




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Character References
Please list three people unrelated to you who know you well, either personally or in business.
1. Name _____________________________ Relationship ____________________________ Phone (_______)_______-_______________
2. Name _____________________________ Relationship ____________________________ Phone (_______)_______-_______________
3. Name _____________________________ Relationship ____________________________ Phone (_______)_______-_______________
Signature of AppIicant

_____________________________________________ Date: _________________
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Please list any training, awards, certifications, achievements, or professional organizations related to the position you are seeking.
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________

Have you ever served in the military? Yes No Rank at retirement/discharge if applicable ____________________________

Are you a citizen of the United States and/or have permission to work in this state and country? Yes No
Education - High School & After
Name of SchooI Location Time Attended Did you graduate? Awards Received Major Subject





Authorization
f you are hired by this company, you will be required to attest to your identity and employment eligibility, and to present documents confirm-
ing your identity and employment eligibility. You cannot be hired if you cannot comply with these requirements.

understand that filling out this form does not indicate that there is a position open and does not obligate the company to hire.

understand and agree that nothing contained in this application, or conveyed during any interview, is intended to create an employment con-
tract. further understand and agree that if am hired, my employment will be "at will and without fixed term, and may be terminated at any
time, with or without cause and without prior notice, at the option of either myself or the company. No promises regarding employment have
been made to me, and understand that no such promises or guarantee is binding upon the company unless made in writing.

I certify that the facts contained in this appIication are true and compIete to the best of my knowIedge. I understand that any faIse
statement, omission, or misrepresentation on this appIication is sufficient cause for refusaI to hire, or dismissaI if I have been em-
pIoyed, no matter when discovered by the company. I authorize the company to investigate aII statements contained in my appIica-
tion and authorize my former empIoyers and references to discIose regarding information my former empIoyment, character and
generaI reputation to the company without prior notice.
FOR OFFICE/MANAGER USE ONLY
SS# ________-______-__________
PHOTO ID FILED